高费用患者占医疗保健费用的大部分，并且具有高度异质性。本研究旨在将高费用患者分为临床同质的亚组，描述亚组的医疗保健利用模式，并确定中国农村地区可预防住院费用 (PIC) 相对较高的亚组。河南省县。确定了 32 108 名高费用患者，代表总支出最高的前 10%。采用基于密度的聚类算法结合专家意见对高费用患者进行分组。描述了各亚组的医疗保健利用率（包括入院、住院时间和门诊就诊）和支出特征（包括总支出以及PIC、住院和自付费用占总支出的比例）。 PIC 是根据潜在可预防的住院治疗 (PPH) 计算的，该住院治疗是根据医疗保健研究机构和质量预防质量指标算法确定的。高费用患者更有可能年龄较大（平均值 = 51.87，SD = 22.28）、男性（ 49.03%）和来自贫困家庭的患者（37.67%）高于非高费用患者，每年入院人数为 2.49 人次（SD=2.47），门诊人次为 3.25 人次（SD=4.52）。确定了14个高费用患者亚组：慢性病、需要手术的非创伤性疾病、女性疾病、癌症、眼病、呼吸道感染/炎症、皮肤病、骨折、肝病、眩晕综合征和脑梗塞、精神疾病、关节炎、肾衰竭和其他神经系统疾病。年入院人数范围为 1.83（SD=1.23，骨折）至 12.21（SD=9.26，肾功能衰竭），平均住院时间范围为 6.61（SD=10.00，眼部疾病）至 32.11（SD=28.78，精神疾病） ) 子组之间的天数。慢性病亚组的PIC占总支出的比例最大（10.57%）。高费用患者被分为14个临床不同的亚组，这些亚组具有不同的医疗保健利用和支出特征。亚组可能需要不同的有针对性的策略来减少可预防的住院治疗。应优先考虑高费用的慢性病患者。© 2024 作者；由克尔曼医科大学出版这是一篇根据知识共享署名许可证 (http://creativecommons.org/licenses/by/4.0) 条款分发的开放获取文章，允许不受限制地使用、分发和复制任何媒体，只要正确引用原始作品即可。

High-cost patients account for most healthcare costs and are highly heterogeneous. This study aims to classify high-cost patients into clinically homogeneous subgroups, describe healthcare utilization patterns of subgroups, and identify subgroups with relatively high preventable inpatient cost (PIC) in rural China.A population-based retrospective study was performed using claims data in Xi county, Henan province. 32 108 high-cost patients, representing the top 10% of individuals with the highest total spending, were identified. A density-based clustering algorithm combined with expert opinions were used to group high-cost patients. Healthcare utilization (including admissions, length of stay, and outpatient visits) and spending characteristics (including total spending, and the proportion of PIC, inpatient and out-of-pocket spending on total spending) were described among subgroups. PIC was calculated based on potentially preventable hospitalizations (PPHs) which were identified according to the Agency for Healthcare Research and Quality Prevention Quality Indicators algorithm.High-cost patients were more likely to be older (Mean=51.87, SD=22.28), male (49.03%) and from poverty-stricken families (37.67%) than non-high-cost patients, with 2.49 (SD=2.47) admissions and 3.25 (SD=4.52) outpatient visits annually. Fourteen subgroups of high-cost patients were identified: chronic disease, non-trauma diseases which need surgery, female disease, cancer, eye disease, respiratory infection/inflammation, skin disease, fracture, liver disease, vertigo syndrome and cerebral infarction, mental disease, arthritis, renal failure, and other neurological disorders. The annual admissions ranged from 1.83 (SD=1.23, fracture) to 12.21 (SD=9.26, renal failure), and the average length of stay ranged from 6.61 (SD=10.00, eye disease) to 32.11 (SD=28.78, mental disease) days among subgroups. The chronic disease subgroup showed the largest proportion of PIC on total spending (10.57%).High-cost patients were classified into 14 clinically distinct subgroups which had different healthcare utilization and spending characteristics. Different targeted strategies may be needed for subgroups to reduce preventable hospitalizations. Priority should be given to high-cost patients with chronic diseases.© 2024 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.